Where is Maine’s Public Health?
Dora Anne Mills, MD, MPH Director, Maine CDC/DHHS
What direction are we going in?
Where is Maine compared with the nation?
What are our major challenges?
What are our successes?
How do we know?
• Healthy Maine 2010: Longer and Healthier Lives for All
• State Health Plan: Maine is the Healthiest State in the Nation
Access to Quality Health Care, Disease Prevention, and Health Promotion
GOAL: Improve access to comprehensive, highquality health care services and effective prevention interventions.
Proportion Of People Of All Ages With Health Insurance Maine And US 1990-2005
M aine P eo ple Of A ll A ges With Health Insurance 1 00% 1 00% US P eo ple Of A ll A ges With Health Insurance
90%
88.8%
88.9%
88.9%
88.9% 87.9% 86.9% 86.5% 85.1 % 87.3% 89.2% 89.7% 89.1 % 88.7% 89.6% 89.6% 89.2%
86.1 %
85.9% 85.0% 84.7% 84.8% 84.6% 84.4% 83.9% 83.7%
85.5%
85.8%
85.4% 84.8% 84.4% 84.4% 84.1 %
80%
1990
1992
1994
1996
1998 Baseline
2000
2002
2004
Healthy Maine 2010 Target
Proportion Of Adults With A Usual Primary Care Provider Maine 1996 -2004
90% 89.1 % 88.1 % 87.9%
85.9% 85.0% 85%
80%
78.0% 77.0%
75%
1996
1999
2001
2002
2003
2004
Healthy People 2010 Target
Proportion Of Kindergarten And Third Grade Children With A History of Decay Maine 1999 and 2003/2004
Children in Kindergarten Children in 3rd Grade
60% 55% 50% 44.7% 45% 40% 35% 30% 25% 20% 1 5% 1 0% 41 .0%
No te: A histo ry o f decay means that a child either had a cavity, a filling, o r a to o th that was missing due to an extractio n.
31 .4% 27.0%
25%
1999 History of Decay
2003-2004 History of Decay
Healthy Maine 2010 Target
Developmental
Increase the number of communities in Maine that have a community health promotion program that addresses multiple Healthy Maine 2010 focus areas.
Developmental
Increase the number of geographic areas in Maine that have a health improvement plan linked to Healthy Maine 2010 goals and objectives.
Developmental
Increase the number of dental providers located in designated Dental Health Professional Shortage Areas where Medicaid-eligible individuals are able to receive dental care.
Summary Report Card Access
• Making Progress
Increasing Access to Primary Care Providers Increasing Access to Health Insurance Decreasing Proportion of Children With Dental Decay
• No Progress or Wrong Direction
Chronic Disease
GOAL: Reduce the number of new cases as well as improve early detection and treatment of chronic disease.
Diabetes
Proportion Of Maine Adults With Diabetes Who Have Taken A Course Or Class In Managing Diabetes
85%
80.0% 80%
75%
70%
65% 62.3% 61 .5% 60.1 % 60% 56.6% 55% 52.9% 56.5%
50%
Baseline 2000
2001
2002
2003
2004
2005
Healthy Maine 2010 Target
Proportion Of Adults With Diabetes Who Had A Dilated Eye Exam In The Past Year Maine 1995-2003 / 3-Year Averages
90.0%
85.0%
80.0%
74.0%
73.4%
70.0%
68.0%
60.0%
50.0%
1995-1997
1998-2000 Baseline
2001-2003
Healthy Maine 2010 Target
Proportion of Maine Adults With Diabetes Who Had A Hemoglobin A1c Test Within The Past Year
1 00.0%
95.0%
88.0% 87.0% 86.4% 84.8% 84.5%
80.0%
78.3%
60.0%
Baseline 2000
2001
2002
2003
2004
2005
Healthy Maine 2010 Target
Mainers with Diabetes 1988-2005
90,000
80,000 74,673 71 ,557 70,000 64,931
76,683
77,21 9
60,000 56,449
50,41 5 50,000 45,848 42,355 40,000 38,1 79 42,21 1 39,449 37,927 34,1 4 1 No data available fo r 1 992 and 1 993 32,331 33,495
30,000
20,000
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Long Term Benchmarks: Be the #1 State
*** DRAFT ***
Source: Dirigo Health
Long Term Benchmarks: Be the #1 State
*** DRAFT ***
Source: Dirigo Health
Summary Report Card Diabetes
• Making Progress
• No Progress or Wrong Direction
Adult Diabetics Taking Classes (40% have never taken a class!) Adult Diabetics Having Had Eye Exam (27% have not had one within one year!) Adult Diabetics Having Had HgA1c (22% have not had within one year!) Diabetes Rates – Incidence and Death
Asthma and COPD
Proportion of Adults With Asthma Maine and U.S. - 2005
1 5.0%
10.2%
1 0.0%
8.0%
5.0%
0.0%
Maine
U.S.
Proportion of Children With Asthma 2004
20% 1 8%
15.8%
1 6%
1 4%
11.6%
1 2%
1 0%
8%
6%
4%
2%
0%
Maine
U.S.
Long Term Benchmarks: Be the #1 State
*** DRAFT ***
Source: Dirigo Health
Summary Report Card Asthma & COPD
• Making Progress
Surveillance Systems for Asthma COPD Deaths
• No Progress or Wrong Direction
Proportion of Maine Children and Adults with Asthma Asthma Hospitalizations
Cardiovascular Disease
Proportion Of Adults Who Have Had Their Cholesterol Checked Within The Past 5 Years Maine And US Selected Years 1993-2005
M aine A dults 85% US A dults
80%
78.7% 76.9% 77.4%
75%
73.2% 71.8%
70%
69.7% 68.3%
72.5% 68.0%
67.2%
69.1%
69.1%
67.3%
65%
65.1%
60%
1993
1994
1995
1996
1997
1999 Baseline
2001
2003
2005
Healthy Maine 2010 Target
Long Term Benchmarks: Be the #1 State
*** DRAFT ***
Source: Dirigo Health
Long Term Benchmarks: Be the #1 State
*** DRAFT ***
Source: Dirigo Health
Summary Report Card Cardiovascular Disease
• Making Progress
Stroke and Heart Disease Deaths Cholesterol and Blood Pressure Checks
• No Progress or Wrong Direction
Cancer
Leading 4 Cancers That Kill Maine People Incidence And Mortality Rates
Age-Adjusted Rate Per 100,000 Population
Maine 2001-2003
Incidence M o rtality
1 75
167.7
1 55 No te: M o rtality rates wo uld be expected to decline o nly if incidence and/o r percentage o f latestage disease declines (treatment advances have no t recently been respo nsible fo r dramatic changes in survival.)
1 35
131.1
15 1
95
76.9
75
61.4
55
56.9
35
24.3
29.1 20.7
1 5
Lung Cancer (both sexes)
Female Breast Cancer
Prostate Cancer (males)
Colorectal Cancer (both sexes)
Mammogram And Clinical Breast Exam Women Aged 50+ Proportion Receiving Both Within The Preceding Year Maine 1990-2004 and US 1998
M aine Wo men 80.0% US Wo men
70.0% 70%
65.0% 63.4% 59.5% 62.3% 61.6%
60.0%
58.2% 56.9% 53.7% 53.4% 50.1% 49.6%
58.3%
52.7%
50.0%
43.8%
40.0%
1990
1991
1992
1993
1994
1995
1996
1997
1998 Baseline
1999
2000
2002
2004
Healthy Maine 2010 Target
Proportion Of Women Aged 18 And Older Receiving A Pap Smear In The Past 3 Years Maine and US 1992-2004
M aine Wo men 1 00.0% US Wo men
95.0%
91.7% 89.7% 88.0% 86.1% 85.5%
85.0%
92.0%
90.0%
89.5% 88.1%
89.0% 88.8% 86.8%
84.6% 85.4% 84.1% 84.7% 84.5% 83.7% 84.6%
85.0% 85.5% 84.8%
86.8%
85.9%
80.0%
1992
1993
1994
1995
1996
1997
1998 Baseline
1999
2000
2002
2004
Healthy Maine 2010 Target
Proportion of Adults Aged 50+ Who Report Having Colon Cancer Screening (Fecal Blood Test Within 2 Years or Sigmoidoscopy/Colonoscopy Within 5 Years) Maine 1998 and 2004
70%
66%
60%
51%
50%
40%
1998
2004
Proportion of Adults Who Use Protective Measures to Reduce the Risk of Skin Cancer Maine 1999 and 2004
100%
90%
80%
72% 70%
70%
60%
50%
1999
2004
Percent of Cancer Diagnosed in Local vs. Distant Stages Female Breast Cancer
Local
80%
Distant
70%
67%
66%
60%
50%
40%
30%
20%
10%
4%
0%
4%
Maine 1995-1997
Maine 2001-2003
Percent of Cancer Diagnosed in Local vs. Distant Stages Colorectal Cancer
Local 50% Distant
44%
40%
37%
30%
20%
17%
16%
10%
0%
Maine 1995-1997
Maine 2001-2003
Percent of Cancer Diagnosed in Local vs. Distant Stages Prostate Cancer
Local
90%
Distant
81%
80%
72%
70%
60%
50%
40%
30%
20%
10%
7% 4%
0%
Maine 1995-1997
Maine 2001-2003
Long Term Benchmarks: Be the #1 State
*Age-Adjusted Invasive Cancer Incidence Rate **43rd out of 45 states and DC. Data not available for: AR, VA, TN, SD, MS, WY.
*** DRAFT ***
Source: Dirigo Health
Long Term Benchmarks: Be the #1 State
*** DRAFT ***
Source: Dirigo Health
Summary Report Card Cancer
• Making Progress
Cancer Incidence and Death Rates Screenable Cancer Diagnosed in Earlier Stages Colon Cancer Screening Pap Smears
• No Progress or Wrong Direction
Mammogram Rates Skin Cancer Protective Measures
Environmental Health
GOAL: Promote health for all through a healthy environment.
Survey Respondants Aware of the Bureau of Health's "Safe Eating Guidelines" for Fish Intended to Reduce Exposure to Methylmercury 1998-2004
1 00%
90%
No te: 1 998 and 2000 data are drawn fro m samples o f wo men o f childbearing age. 2004 data was drawn fro m a sample o f wo men who had already given birth. 80%
60%
60%
41%
40%
32%
20%
1998
2000
2004
Healthy Maine 2010 Target
Proportion Of Maine Homes with Wells That Have Tested Their Water for Arsenic 2000/2001 and 2003
80%
75%
70%
60%
50%
40%
30%
27%
20%
11%
1 0%
0%
2000/2001
2003 BRFSS
Healthy Maine 2010 Target
Trends in Number of Children with Elevated Blood Lead Levels 1997 - 2004
500
20%
412
400
398 16.7% 336 330 327 292 13.2% 12.2% 11.8% 11.8% 16.9% 16.7%
15%
Number of Children with EBLL
300
12.4%
253 211
10%
200
5% 100
0
0%
1997
1998
1999
2000
2001
2002
2003
2004
Children with BLL >= 10 ug/dl
Children <72 Months Screened Annually
Percent of Children Screened
Summary Report Card Environmental Health
• Making Progress
Unhealthy Ozone Days Fish Guidelines Childhood Lead Poisoning Private Well Water Testing
• No Progress or Wrong Direction
Family Planning and Perinatal Health
GOAL: Improve pregnancy planning and spacing, prevent unintended pregnancy, and improve the health of women and infants.
Summary Report Card Family Planning & Perinatal Health
• Making Progress
Teen Pregnancy
• No Progress or Wrong Direction
Infant Mortality
Infectious Disease and Immunization
GOAL: Prevent disease, disability, and death from infectious diseases, including vaccine-preventable diseases.
Proportion of Adults Aged 65 and Older Who Received a Flu Shot Within the Past 12 Months Maine and US 1993-2005
Maine Adults 95% 90% 90% 85% 80% 75% 70% 65% 65% 60% 60% 55% 51% 50% 50% 45% 1993 1995 1997 1999 Baseline 2001 2003 2005 Healthy Maine 2010 Target 66% 74% 75% 72% 70% 67% 66% 68% 66% US Adults
72%
Tuberculosis by Year Maine 2000-2005 30
25
24 20
23
24 20 17
Cases
20
15
10 2000 2001 2002 2003 2004 2005
Year
8.5
Infections Caused By Foodborne Pathogens Maine 2000-2005
Campylobacter Salmonella
14
Escherichia Coli Cyclospora Cayetanesis
13.20
Listeria Monocytogenes Postdiarrheal Hemolyticuremic Syndrome
12
11.7
12.40 12.0 11.50 11.0 11.00 11.0 11.1
10
10.00
9.7 8.60
Number of Infections
8
8.5
6
6.3
4
3.1 2.5
2
2.3 1.3 .6 .2 0 0 2003 .2 .7 0 2005 HM 2010 Target
1.0 .8 .2
0
1.2
1.5 0/0 .2
.2 0 0 2001 .24
.4
.5
2000
2002
2004
Chlamydia Infection Rates By Gender Ages 15-24 2001-2005
Females
1400 1,313
Males
1,202 1200 1,127 1,057 1000 1,148
Number of Infections
830 800
600
400 300 267 200 185
359
374
350
0 2000 Baseline 2001 2002 2003 2004 2005
Maine Residents with Concurrent HIV/AIDS Diagnoses* 2000 - 2004
25
20
22
22 21 19 19
15
Number
10
12
5
0
2000
2001
2002
2003
2004
5 year mean
*Concurrent diagnoses are defined as an AIDS diagnosis w ithin one year of a patient's first HIV-positive test.
Summary Report Card Infectious Disease & Immunization
• Making Progress • No Progress or Wrong Direction
• • • • • Flu Shots for Seniors Vaccination Rates Among 2-Year Olds Tuberculosis Food Borne Pathogens HIV/STDs
Injury
GOAL: Reduce injuries, disabilities, and deaths due to unintentional injuries, suicide, and violence.
Adults Currently Using Safety Belts Maine and US Selected Years 1990-2002
M aine A dults Who Repo rt A lways o r Nearly A lways Using A Car Safety B elt US A dults Who Repo rt A lways o r Nearly A lways Using A Car Safety B elt 1 00%
82.1%
80%
83.5%
86.0% 86.5% 83.8%
92.0%
79.5%
60%
61.8% 58.1% 52.0%
60.2%
61.4%
62.1%
40%
1990
1991
1992
1993
1994
1995
1997 Baseline
2000
2001
2002
Healthy Maine 2010 Target
Deaths Due to Falls Older Adults Aged 65-84 and 85+ Maine and US 2000-2004
Fall Deaths Age 65-84 160 140 120.1 120 100 80 60 40 20 0 Maine 2000 US 2000 Maine 2002 US 2002 Maine 2004 15.0 18.1 22.9 22.1 10.9 111.1 95.7 131.9 130.4 Fall Deaths Age 85+
Summary Report Card Injury
• Making Progress
Child Abuse
• No Progress or Wrong Direction
Motor Vehicle Crashes Deaths Due to Falls Among Seniors Assault Injury Hospitalizations Safety Belt Usage
Mental Health
GOAL: Improve mental health and ensure access to appropriate, quality mental health services.
Maine BRFSS Data,1999-2004 14,250 respondents
• Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? • No Mental Distress: 68.5% N=9761
• Frequent Mental Distress (FMD): 14 days or more: 10.4% N=1489
Unhealthy (Frequent) Mental Distress Days Maine and US 2001-2005
15.0
10.8 10.1
10.0
Number of Days
5.0
0.0
Maine
US
0 Days Mental Distress Compared to 14 or More Days
Days of Mental Distress
Smoking Obesity Heavy Drink No Exercise
0 Days
20% 19.3% 4.8% 23%
14 or more
40% 28.2% 7.1% 34%
5/more fruit
19.3%
2.7%
0 Days Mental Distress Compared to 14 or More Days
Days of Mental Distress High BP High Cholesterol
0 Days 26.6% 31.3%
14 or more 32% 38.6%
Diabetes Asthma
6.4%
11.5%
11.2%
21.5%
Long Term Benchmarks: Be the #1 State
*** DRAFT ***
Source: Dirigo Health
Summary Report Card Mental Health
• Making Progress • No Progress or Wrong Direction
Self-Inflicted Injuries Co-occurring Health Challenges Days of Frequent Mental Distress
Occupational Health
GOAL: Promote the health and safety of people at work through prevention and early intervention.
Summary Report Card Occupational Health
• Making Progress
Work-Related Deaths
• No Progress or Wrong Direction
Occupational Injuries
Physical Activity and Nutrition
GOAL: Improve health, fitness, and quality of life through daily physical activity and good nutrition.
Proportion of Maine And US Adolescents Grade 9-12 Who View Television Two Or Fewer Hours Per Day
Maine and US 1999 and 2001, Maine 2003 and 2005
P ro po rtio n o f M aine A do lescents Who View Televisio n Two Or FewerHo urs P er Day P ro po rtio n o f US A do lescents Who View Televisio n Two o r Fewer Ho urs P er Day 90%
85%
80%
76.0%
75.6% 73.7% 73.2%
70%
62%
60%
57%
50%
1999
2001
2003
2005
Healthy Maine 2010 Target
Proportion Of Maine And US Adolescents Engaged In Moderate* Physical Activity
Maine and US 1995-2001, Maine 2003-2005
P ro po rtio n Of M aine A do lescents Who Engage In M o derate P hysical A ctivity P ro po rtio n Of US A do lescents Who Engage In M o derate P hysical A ctivity
50%
*P hysical activity fo r at least 30 minutes o n 5 o r mo re o f the previo us 7 days.
40.0% 40% 32.7% 30%
26.7%
29.1%
25.5%
24.6%
25.6%
21 % .1
20%
19.1%
20.4%
17.7%
10%
0%
1 995 1 997 1 999 2001 2003 2005 Healthy M aine 201 0 Target
Proportion of Maine and US Adults Who Engage in No Leisure Time Physical Activity 1994-2005
Maine
45.0%
US
40.0%
40.7%
35.0%
34.0%
30.0%
27.7%
28.8% 27.8% 25.0% 24.4% 27.7% 26.9% 23.1% 23.9% 22.8%
27.2%
25.7%
25.8%
23.2% 22.3%
20.0%
21.5% 20.6%
20%
15.0%
1994
1996
1998
2000
2001
2002
2003
2004
2005
HM 2010 Target
Proportion Of Maine And US Adolescents Consuming At Least 5 Or More Servings Of Fruits And Vegetables A Day 1995-2005
P ro po rtio n Of M aine A do lescents Co nsuming A t Least 5 Or M o re Servings Of Fruits A nd Vegetables A Day P ro po rtio n Of US A do lescents Co nsuming A t Least 5 Or M o re Servings Of Fruits A nd Vegetables A Day
40.0% 36.0% 32.0% 28.0%
34.5% 32.4%
35%
29.3% 27.7%
26.7% 25.0% 23.9% 22.6% 21.4% 23.2% 18.9%
24.0% 20.0% 1 6.0% 1 2.0% 8.0% 4.0% 0.0%
1995
1997
1999
2001
2003
2005
Healthy Maine 2010 Target
Proportion Of Maine And US Adults Consuming At Least 5 Or More Servings Of Fruits And Vegetables A Day 1994-2005
P ro po rtio n Of M aine A nd US A dults Co nsuming A t Least 5 Or M o re Servings Of Fruits A nd Vegetables A Day P ro po rtio n Of US A nd US A dults Co nsuming A t Least 5 Or M o re Servings Of Fruits A nd Vegetables A Day 40%
35%
30%
29.4% 26.2% 26.4% 24.5% 23.8% 23.1%
27.0%
28.7%
30%
25%
21.1%
20%
23.6%
1 5%
1 0%
5%
0%
1994
1996
1998
2000
2002
2003
2005
Healthy Maine 2010 Target
So urce: M aine Department o f Human Services, B ureau o f Health, M aine B ehavio ral Risk Facto r Surveillance System. 1 994, 1 996, 1 998 and 2000. Natio nal data: B ehavio ral Risk Facto r Surveillance System 1 990-2000, Centers fo r Disease Co ntro l and P reventio n.
Proportion Of Maine Adolescents Who Are Overweight 2001-2005
1 5.0%
12.8%
10.9% 10.4%
1 0.0%
5.0%
5.0%
0.0%
2001
2003
2005
Healthy Maine 2010 Target
Proportion Of Maine Adults Age 18 And Older Who Are Obese Or Overweight 1990-2005
P ro po rtio n Of M aine A dults Who A re Overweight P ro po rtio n Of M aine A dults Who A re Obese 40%
36.4% 34.4%
35%
37.0% 35.8% 37.6% 37.0% 35.4%
37.9% 36.3% 39.3% 38.3%
37.6% 36.9%
32.6%
30%
36.6% 34.5%
30%
25%
23.3% 20.0% 20.7% 22.7% 19.5% 19.9%
20%
15.2%
1 5%
16.1% 16.2%
17.4%
19.4%
12.2%
1 0%
12.1% 13.7% 12.5%
14.1%
1 990
1 991
1 992
1 993
1 994
1 995
1 996
1 997
1 998 Baseline
1 999
2000
2001
2002
2003
2004
2005
Healthy Maine 201 0 Target
Summary Report Card Physical Activity and Nutrition
• Making Progress
Adult Physical Activity Adult Fruits and Vegetables
• No Progress or Wrong Direction
Youth TV Watching Youth Physical Activity Youth Fruits and Vegetables Youth and Adult Overweight
Substance Abuse
GOAL: Reduce substance abuse, including tobacco use and exposure to secondhand smoke, to protect the health, safety, and quality of life for all, especially children.
Alcohol Binge Drinking Adults Aged 18 And Older Maine And US Select Years 1990-2002
Maine Adults
20.0%
US Adults
Al c ohol Bi n ge D ri n ki n g Adu l t s Aged 18 An d O l der M ai n e An d US Sel ec t Years 1990-2002
Note: Binge drinking is defined as consuming five or more drinks on an occasion, one or more times in the past month.
15.3%
15.0%
30. 0% 14.5%
Maine Adults
US Adults
16.1% 15.4% 15.4%
16.8% 16.5% 14.9% 14.4% 14.0%
14.4%
14.3%
14.1%
14.5%
14.9% 14.8%
N o t e: Binge drinking is defined as consuming five or more drinks on an occasion, one or more times in the past month.
14.7%
20. 0% 15. 3% 14. 5%
13.8%
14. 4% 14. 3% 11. 6% 9. 2% 14. 1% 11. 5% 14. 5% 13. 8% 14. 9% 14. 8% 15. 4% 14. 7% 16. 1% 15. 4%
11.6%
11.5%
10.0%
10.5% 10. 0% 10.4%
10. 5%
10. 4%
9.2%
0. 0%
5.0%
1990
1991
1992
1993
1995
1997
1999
2001
2002
0.0%
1990
1991
1992
1993
1995
1997
1999
2001
2002
2003
2004
2005
Adolescent Heroin Use Students Grades 9-12 Who Used Heroin One or More times During Their Life Maine and US 2001 and 2005
Maine 10.0% US
9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
3.9% 3.5% 3.1%
3.0%
2.4%
2.0%
1.0%
0.0%
2001
2005
Adolescent Marijuana Use Adolescents (Grades 9-12) Who Used Marijuana One Or More Times During The Past 30 Days Maine And US Select Years 1995-2005
Maine Adolescents US Adolescents 40.0%
35.0%
30.4%
30.0%
28.4%
27.2% 26.2% 23.9%
26.4% 22.2% 22.4% 20.2%
25.0%
25.3%
20.0%
15.0%
10.0%
5.0%
0.0%
1995
1997
2001
2003
2005
Cigarette Smoking Among Adolescents (Grades 9-12) Maine And US 1993-2005
Maine Adolescents (Grades 9-12) US Adolescents (Grades 9-12) 50.0% *1993 and 1999 Maine YRBS data are unweighted, so cannot be reliably used for comparison.
40.0%
37.8% 32.6% 34.8%
39.2% 34.8% 36.4% 28.5%
30.0%
30.5% 28.6% 21.9% 24.8% 23.0% 20.5% 16.2% 15%
20.0%
10.0%
0.0% 1993 1995 1997 1999 Baseline 2001 2003 2005 Healthy Maine 2010 Target
Cigarette Smoking Adults Maine And US 1990-2005
Maine Adults 30% US Adults
27.0% 26.1% 25% 23.3% 23.0% 23.1% 24.7% 23.6% 23.4% 22.6% 22.7% 22.4% 22.2% 22.7% 22.4% 22.6% 25.0% 25.3% 23.8% 23.2% 23.8% 23.9% 23.2% 22.0% 21.0% 20.8% 20.9% 20.6%
1 9%
23.2%
22.9%
23.3%
23.6% 23.7%
20%
15% 1990 1992 1994 1996 1998 Baseline 2000 2002 2004 Healthy Maine 2010 Target
Tobacco Consumption Trends In Packs Of Cigarettes Consumed Per Adult In Maine, New Hampshire and US 1990-2005
New Hampshire
180
*2001 data use 2000 population data for Maine
Maine
US
174.4
173.8
171.7
160 158.5 152.4 140 144.8 148.9 143.7 153.8 147.3 136.1 120 117.5 116.1 114.5 108.5 101.6 100 104.4 100.4 98.7 97.6 96 95.8 93.3 94.5 102.3 100.0 101.1 94.5 85.5 93.4 89.9 85.2 82.9 81.2 81.8 131.6 158.0 146.2 148.1 138.6
79.6 79.8
80
74.6 78.7
76.2
75 71.5
72.4 60 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
2005
Source for NH data: Tax Burden on Tobacco, Historical Compilation, Vol. 36, by Orzekow sky and Walker. NH does not use intercensal estimates for population, according to NH State Planning Office, partly accounting for abrupt change at 2000. Source for Maine data: Maine Revenue Services (Also published in Tax Burden, etc.). Intercensal population estimates from Maine Department of Human Services, Bureau of Health, Office of Data, Research and Vital Statistics.
Proportion Of Pregnant Women Smoking During The Last 3 Months Of Pregnancy Medicaid And Non-Medicaid Insured Maine 1990-2003
Non-Medicaid 50.0% 43.3% 40.0% 39.5% 38.9% 35.7% 30.2% 30.0% 35.5% 35.9%
'
Medicaid At Any Time
39.8% 36.8%
38.2% 36.1% 31.2% 33.1% 28.9%
20.0%
15.8%
16.4% 12.5% 12.7% 10.5% 13.0% 10.0% 9.9% 8.6% 8.1% 9.0% 6.0% 4.9% 7.0%
20%
10.0%
0.0% 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Baseline 2000 2001 2002 2003 Healthy Maine 2010 Target
Summary Report Card Substance Abuse
• Making Progress
Youth Marijuana Use Youth and Adult Cigarette Smoking Tobacco Consumption Pregnant Women Smoking
• No Progress or Wrong Direction
Adult Binge Drinking Youth Heroin Use
Great Tobacco Successes, But Challenges Remain!
November, 1996: Maine #1 for Young Adult Smoking • 1995 • 2004 34% 36%
43% of smokers with children have no rules on smoking in their home.
So, how is public health doing in Maine?
• Overarching Goals • Healthy Maine 2010: Longer and Healthier Lives for All • Maine State Health Plan: Maine is the Healthiest State in the Nation
Some Major Cross-Cutting Public Health Challenges in Maine
1. Ongoing Work on Public Health Infrastructure
2. Disparities
Even our successes show great challenges with disparities:
- 40% of the uninsured smoke
- 20% of the insured smoke
- 55% of 18-44 year old MaineCare (Medicaid) recipients smoke
Racial and Ethnic Minority Disparities
• Successes: Office of Minority Health • Challenges: Data – No Data? – No Problem!
Poverty
• Challenges: Addressing the health
disparities of poverty
Gender Disparities
• Successes: Office of Women’s Health and
Women’s Health Plan for Maine • Challenges: Addressing gender disparities throughout our interventions
Sexual Minority Disparities
• Successes: Decreasing the legal inequities • Challenges: Data and addressing disparities
Age, Rural/Urban, Disability, Veteran Status Disparities
• Challenges: Data and addressing disparities
3. Workforce Development
Challenges: Much of our workforce has no formal public health training
Successes: UNE has online MPH program; USM has a focus on public health
4. Public Health is Part of a National Health System in Crisis
More spending does not mean better health…
• The US ranks 24th in overall health attainment, just above Cyprus.*
*Source: World Health Organization, The World Health Report 2000: Health Systems: Improving Performance. Geneva, Switzerland, 2000
*** DRAFT ***
The Problem: Cost, Quality, & Access
• Dirigo Health Reform: a comprehensive approach to lowering cost growth and improving access to quality health care. • The State Health Plan is a vital component of Dirigo Reform.
*** DRAFT ***
Source: Dirigo Health
5. Public Health Identity
- Adverse Childhood Experiences - Agriculture - Assets/Resiliency - Economic Development - Education - Environment - Health Care - Infrastructure - Public Safety - Social Services - Transportation
All are public health.
WE ARE ONE!
Public health is also distinctive.
Public Health:
Measured outcomes are health outcomes - Distinct profession - Distinct strategies
-
When we work together as distinct partners with common goals, we can accomplish much more.
Some Public Health Successes in Maine
Public Health is on the Agenda!
Fire/Police Conference Pandemic Conference 12/05 Maine Public Health Association Education Conference Maine Municipal Conference Immunization Conference Infectious Disease GrowSmart Sprawl Pandemic Influenza 9/06 200 250 350 400 400 400 450 600 1,100
We have a road map for success.
We have great visions!